Russell, Thomas Joseph

Russell, Thomas Joseph is an individual health care provider with primary practice located at 13800 W North Ave Ste 100, Brookfield WI 53005-4974. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Russell, Thomas Joseph can be contacted via phone (262) 754-4488.

Contact Information

Primary practice address
13800 W North Ave Ste 100 Brookfield WI 53005-4974
Phone: (262) 754-4488
Fax: (262) 754-4940
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 15093020 Wisconsin

Profile Details

NPI number 1528051166
LBN Legal business name Russell, Thomas Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 2005
Last updated Apr 20th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528051166 NPPES
Wisconsin MEDICAID 30899900

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